Summary & Overview
CPT 90846: Family Psychotherapy Without Patient Present, 50 Minutes
CPT code 90846 is a nationally recognized billing code for family psychotherapy sessions conducted without the patient present, lasting 50 minutes. This code is widely used by mental health professionals, including clinical psychologists, clinical social workers, and psychiatric/mental health nurse practitioners, to address family dynamics and support treatment plans for patients with psychiatric conditions. The service is typically delivered in an office setting and is covered by major payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare.
This publication provides a comprehensive overview of CPT code 90846, including payer coverage, clinical context, and related billing codes. Readers will gain insights into the scope of services, common modifiers for telemedicine, and associated taxonomies. The analysis also highlights relevant ICD-10 diagnoses, such as obsessive–compulsive disorder and related disorders, and compares CPT 90846 to related codes like CPT 90847 and CPT 90785. The report is designed to inform healthcare professionals, billing specialists, and policy analysts about current benchmarks and policy updates for family psychotherapy services.
CPT Code Overview
CPT code 90846 represents family psychotherapy without the patient present, typically conducted for 50 minutes. This service is classified under psychiatry/psychology and is most commonly provided in an office setting (Place of Service 11). The procedure involves therapeutic sessions with family members to address psychological issues impacting the patient, even though the patient is not physically present during the session. This approach is used to support family dynamics and improve outcomes for individuals with mental health conditions.
Clinical & Coding Specifications
Clinical Context
A family member of a patient diagnosed with obsessive–compulsive disorder and related disorders (F42.2 – F42.9) attends a psychotherapy session without the patient present. The session is conducted in an office setting and lasts approximately 50 minutes. The clinician, such as a clinical psychologist, clinical social worker, or psychiatric/mental health nurse practitioner, focuses on helping the family understand the patient's condition, develop coping strategies, and improve family dynamics to support the patient's treatment plan. This service is often part of a broader psychiatric or psychological care plan and may be delivered in-person or via telemedicine, depending on the family's needs and circumstances.
Coding Specifications
-
Modifiers:
-
GT: Used when the service is provided via interactive audio and video telecommunication systems (telemedicine). -
95: Indicates a synchronous telemedicine service rendered via real-time interactive audio and video telecommunications.
-
-
Provider Taxonomies:
Taxonomy Code Specialty Description 103K00000XClinical Psychologist 1041A0400XClinical Social Worker 363LP0800XPsychiatric/Mental Health Nurse Practitioner
These taxonomies represent the specialties eligible to perform and bill for family psychotherapy services without the patient present.
Related Diagnoses
F42.2–F42.9: Obsessive–compulsive disorder and related disorders- These codes represent a range of obsessive–compulsive and related disorders. Family psychotherapy without the patient present is clinically relevant for these diagnoses, as it helps family members understand the disorder, learn supportive strategies, and address family dynamics that may impact the patient's treatment and recovery.
Related CPT Codes
-
90847: Family psychotherapy (conjoint psychotherapy) (with the patient present), 50 minutes- Used when the patient is present during the family psychotherapy session. This code is an alternative to
90846when the clinical situation requires the patient's participation.
- Used when the patient is present during the family psychotherapy session. This code is an alternative to
-
90785: Interactive complexity (List separately in addition to the code for primary procedure)- Used as an add-on code when the psychotherapy session involves factors that complicate communication, such as involvement of third parties or language barriers. This code may be used in conjunction with
90846when appropriate.
- Used as an add-on code when the psychotherapy session involves factors that complicate communication, such as involvement of third parties or language barriers. This code may be used in conjunction with
Both codes are related to 90846 in the context of family psychotherapy and may be used together or as alternatives depending on the clinical scenario.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 90846 is highest among UnitedHealth Group at $147.80, followed by Cigna at $142.75. The average commercial benchmark (BUCA) stands at $128.07, which is $19.32 higher than the Medicare mean rate of $108.75. This highlights a notable gap between commercial and Medicare reimbursement levels for this code.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range at $3.00, indicating minimal variation in rates. In contrast, UnitedHealth Group exhibits the widest spread at $85.33, followed by Cigna at $71.00. This suggests that commercial payers have greater variability in reimbursement rates compared to Medicare.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.